stuward wrote:I don't disagree with you and I'm sure that lots of trainers put their short term monetary gains over their client's long term health, but in the long term, you would both be better off if you correct the pain first. That doesn't mean you can't work on other aspects at the same time.

I've actually lost out on a couple of clients because I refused to train them until they seen a physio. I don't regret it, it's actually helped me as I get a lot of people with pain and i'll tell new people this so they take it as a warning of sorts - If I say they need a physio, they know I really mean it.

Pain is something I mull over, too. In an idea world i wouldn't need to deal with any pain but, can you imagine going to a physio and saying, "my shoulder hurts, but only when I bench over 100KG". Technically, their remit is to get you out of pain and back to daily life. Not bench X amount of weight, or run X amount of miles.

I recently had this conversation, with a recreational runner,

Me: Do you have any injuries, aches, or pains?
Runner: No... Although, my knee hurts when I run.
Me: At what point does it hurt? just in general? a certain distance?
Runner: Actually, it only seems to happen after I hit 3 miles.
Me: Oh, well that's easy - don't run any more than 2.5 miles

I was joking, obviously.

I was always a "if it hurts, refer out", thinking it was a black or white issue but it's not really.

I do have principles, though. I never train someone through or in the presence of pain. However, I will train people with "pain". If I can train them how they need to be trained PAIN FREE, then i'll do it. This pretty much involves working only with "non-painful dysfunction" whilst completely avoiding anything that hurts. Normally, it results in the pain magically disappearing.

Something I've said a lot before, "I can't do anything with your knee, i'm not a physio. I can fix your hips, strengthen your glutes, and improve your movement, though". So, if I can do this without ever having any pain, then I'll do it. If not, I refer out. Of course, I always do a screen etc, and if there's blatant "red flags", I'll refer out anyway. Sometimes people who think they aren't in pain present some real red flags when you screen them. "no pain but, this leg feels very heavy and sometimes kind of numb"...... Um, ok, go see this guy *hands over number for physio*.

As a result, I actually get the respect of a good physio who is known for hating personal trainers. He invites me to the consultations, I send him the programs, call him to discuss the client, etc. It works well.

Also, I don't think trainers should put their hands on clients. That really irritates me. I don't mean light touching to help with coaching i.e. placing fingers between shoulder blades and saying, "break my fingers", I mean trainers who manually stretch their clients. Hamstrings are a popular one. Even if the client needed the hamstrings stretched, which is a big "if", then why not just teach them how to do it themselves? That's what we're supposed to do!!

I recently got a new client with a history of sciatica. She seen another trainer and it didn't go well. He had done a course, which was a weekend course over about 3 months which means he can call himself a "lower back specialist". What an insult to the clinical realm, who, in order to work with patients like that need to study for years, yet can be seen in the same light as a "Lower back specialists" who got qualified via a weekend course. It disgusts me.

Anyway, the other trainer made her worse. I assessed her, got her moving etc. Had to tell her, "look, you clearly have a nerve issue and, i'm not comfortable working with you. As a personal trainer this is completely over my head. I know I can help you but, initially, you need some physiotherapy. You don't need a trainer right now". I told her how I can work in conjunction with him, etc but, right now I can't work with her. I was (and am) very positive about helping her but, she needs MEDICAL intervention first. She had already signed up to do one session per week with me, possibly more. I advised her to hold off on the money she is going to spend on me and direct that to the physio. Honestly, she looked overwhelmed when I said that. She asked if she can book sessions anyway, and she'll see us both. I told her to hold off until she's had the initial consultation. I'm sure it will be fine, but the physio needs to be in charge. I got a heartfelt text message afterwards about how in 20 years of suffering from this, she's never felt like anyone actually cared and, although nothing is happened yet, she has a very good feeling about working with me.

Honestly, that alone is priceless and why I'm trying to do this. I don't think you should ever forget your bottom line. Mine is that I want to help people, first and foremost. It's easy to over look it but clients like that remind me of it. Plus, the alternative would most likely be taking one session for a few weeks and making things worse, imagine what she would say about me then? Right now she talks about me like i'm a genius, even though i've not actually done anything, yet lol.

In discussing movement and what trainers do and do not know, I think it's also important to establish who exactly should know, and what kind of implications this would have on the fitness and health industries going forward. You'll hear no argument from me that a lot of trainers don't have the education and the skills necessary to navigate the unique fitness needs of an individual with compromised movement. My question -- or concern? Why am I always so concerned... -- is whether it's actually the trainers place to make those kinds of assessments, or if that role has been thrust upon the trainer because other professions have dropped the ball or because the problem has grown in such magnitude?

This is where I would normally savage physiotherapy as a modality mired in woefully outdated research and dogma, chiropractic and osteopathy for being quagmired in pseudoscience, and sports doctors for being inaccessible and reductionist, but that just leaves us with a room full of sobbing savagees and a quickly ostracized savager who is no closer to having any answers.

The statistics on the physical state of North Americans are sobering. The laundry list of medications we are on is harrowing. This is an enormous problem to tackle, and I think people are turning to trainers because we're the new kids on the block and they're just looking for solutions where there were none before. Quality of movement wasn't something people thought much about thirty years ago, and the explosion of the fitness industry coincides well with baby boomers realizing the ruins they have smote upon their mountains and a desperate attempt to reverse the tide of a bloated, pain ridden society.

Training as a concept is really just helping people exercise safely, and trainers can be forgiven for not being studious or the industry for not erecting a more suitable barrier for entry. If the population was generally healthy it would be a pretty simple task that would rely more on coaching, motivation and leading by example. That people are coming to us with bodies that are, to use the scientific term, cranked all up off the heazy, is a massive oversight not of training but of everything that should have come before, but didn't.

I recently saw a kid of about 15 with hips that were so jacked up off the hook I'd swear he was Benjamin Button. What happened to playing outside? Phys Ed in schools? Why are we not taking two steps back and in our best Jamie Hyneman monotone exclaiming "well there's your problem?"

Although I probably shouldn't complain too much because it means I'll always have a job...

Don't forget the parent's responsibility to set an example and to encourage healthy habits.

Stu Ward
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Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

stuward wrote:Don't forget the parent's responsibility to set an example and to encourage healthy habits.

I think it's sad how sometimes the responsibility of the parent to actually create a base for healthy living and exercise is forgotten and moved straight to teachers and coaches.

The other huge problem I've witnessed is the parents lack of knowledge. It's sometimes awful to see a father train his son with the poorest and unsafest way possible, telling the kid all kinds of jibberish and making him do stuff with horrible form and wrong kind of exercises. That plus the fact there usually is too much weight used in all exercises. No matter the technique.

Well, to blame parents, you'd have to go back a generation or two--the problems haven't started just in the last 10 or 15 years. The people who are parents now were raised by Sesame Street and Mario. It's my contemporaries who dropped the ball. Or stopped throwing it.

Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

Jungledoc wrote:Well, to blame parents, you'd have to go back a generation or two--the problems haven't started just in the last 10 or 15 years. The people who are parents now were raised by Sesame Street and Mario. It's my contemporaries who dropped the ball. Or stopped throwing it.

I suppose we can do our part by making sure our grandchildren never run out of baseball bats and skipping ropes.

Stu Ward
_________________
Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

Let's even look past assigning blame. How do we fix this? How do we turn this train around? Does a healthcare profession need to step up and offer solutions? Is this the niche trainers need to fill and we have to accept a greater share of responsibility? Could we revitalize PE in schools? Or are we just boned, and those of us who hopped on the mobility bandwagon early can just laugh all the way to the bank?

KPj, let's buy mansions and ferraris and get gold grills in our teeth.